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It's already been in the 90s here in Tulsa, which means we're already shifting to summer mode, even though it's March.
Grilling more, eating outside more, and every year around this time I start looking at the backyard and noticing what's worn out, what's uncomfortable and what needs to be replaced before we're using it every day.
So I've been on Wayfair looking at ways to get things dialed in in our backyard eating area.
Better seating.
Maybe a few smaller things like planters or cushions that make the space more usable.
What I like about Wayfair is how easy it is to narrow things down.
You can filter by size material price, read through a ton of reviews and get a clear sense of what you're buying before you pull the trigger.
And they make the whole process easy fast shipping options and a lot of items come with straightforward assembly or even setup help if you want it, so you're not stuck figuring it out on your own.
It just makes planning and upgrading your space a lot simpler heading into summer.
Find furniture, decor, and essentials that fit your unique style and budget.
Head to Wayfair.com right now and shop all things home.
That's Wayfair.com, W-A-Y-F-A-I-R.com.
Wayfair, every style, every home.
Brett McKay here, and welcome to another edition of the AOM Podcast which, since 2008, has featured conversations with the world's best authors, thinkers and leaders that glean their edifying, life-improving insights, without the fluff and filler.
The AOM Podcast is just one part of the McKay mission to help individuals practice timeless virtues through thought, word and deed.
Also be sure to explore our articles in artofmanliuscom, read the deeper dives we do in our Substack newsletter at dyingbreednet, and turn our content into real-world action by joining the Strenuous Life program at strenuouslifecom.
Now on to the show.
Pooping.
Everybody does it, but a lot of people are embarrassed to talk about it.
That's a shame, my guest says.
Not only because your digestive health is incredibly linked to your overall health, but simply for the fact that there's much happiness to be found in an easy, worry-free constitutional.
Harvard gastroenterologist, Dr Trisha Pushricha, is the author of Human Pooping.
All Wrong.
How to Make Your Bowel Movements a Joy.
Today on the show, Trish and I have a fun and frank conversation about the art and science of bowel movements, including the color of healthy stools, how often you should be pooping.
If laxatives are safe to use the food we eat that's even better than prunes for getting things going and how to make your bowel movements a joy.
Why you feel the urge to go poop at Barnes Noble.
The wonders of the bidet, the danger of using your smartphone on the toilet, how to get more comfortable pooping in a public rest, room and more.
After the show's over, check out our show notes at awimp.is slash poop.
All right, Dr. Trisha Pasricha, welcome to the show.
Thank you so much for having me, Brett.
Glad to be here.
So you are a medical professor of gastroenterology.
That's a hard word to say.
I had to look it up how to pronounce it.
You specialize in gut health and a big part of your work involves researching and talking a lot about poop.
Oh, yeah.
How'd you end up doing what you do?
Well, I kind of am a second generation gastroenterologist.
I grew up as the daughter of a gastroenterologist.
And when you grow up like that, you think that talking about poop every day is perfectly normal.
And you think that that's what everyone else is doing.
And it was delightful.
My father was and still is a gastroenterologist, but he was also a researcher.
And he was just so excited to tell me and my siblings about the cool stuff he was discovering in his lab every day after he came home from work and he was describing how colonoscopies worked and all of this.
I know now sounds really bizarre, but at the time it was just what we talked about at the dinner table and how cool science was, and specifically when it came to our gut.
So I loved it and it was kind of what I grew up thinking was the coolest thing in the world and So I knew I wanted to be a gastroenterologist since I was like a little girl.
I had never imagined wanting to be anything else.
But then, when I came to medical school and then I started doing my own training, I really started to realize what a weird gap there was between what other people seem to have learned about poop and their bowel movements and how their gut works and what I learned.
And people.
For the most part, it seems like didn't really talk about their guts and their poop after they turned like three or four.
And it was like something everyone just like stopped bringing up at the dinner table.
And so I kind of went on this mission and it just started with me talking to my patients about trying to normalize these conversations and having them out loud.
And ultimately that led to writing the book.
But I really do think that people need to have conversations more loudly, because 40 of Americans are suffering from bowel habits that disrupt their daily lives.
But you wouldn't know that because we're so quiet about them.
Yeah, I mean, unlike you, we didn't talk about poop at the dinner table.
I don't even remember having conversations about my bowel movements with my family.
And that carries over, I think, for a lot of Americans to how they approach talking about it with their doctor.
As you said, a lot of Americans have bowel problems and it can cause a lot of discomfort, a lot of inconvenience in their life and a lot of it is preventable.
Let's talk about this.
I think one of the reasons why people have a hard time talking about it is they don't know how to talk about poop.
So when they go to the doctor saying, I got this problem with my bowel movements.
I mean, what should they call it?
Because you're always like, do I call it bowel movement?
Do I get scientific and call it stool, feces, human soil?
Like what do we, what do you call it?
Yeah, liquidating your assets, like whatever you want.
I have found that I use the word poop usually, unless somebody leads with another word that they find more comfortable.
And the reason I do that is when I was in medical training.
The kind of formal word that all doctors use is bowel movement.
And so that's what I was trained to start saying.
And I certainly started saying that.
And I had one professor who was a gastroenterologist and he was my research mentor in medical school.
And I shadowed him.
And he was the first guy I had ever seen, like this doctor, middle-aged gentleman.
And this young patient came in and he was like, so. tell me what your poop looks like.
And I like looked at this guy and I was like, this is so weird.
You're this doctor in this white coat.
That's the weirdest, you know, I've never seen a doctor say that like that in a clinic before.
But when he said it, this young patient in his twenties like suddenly smiled for the very first time.
And like just the whole atmosphere in the room changed.
And this guy just totally shared exactly what was going on with him.
And you could just tell it broke the ice.
It made it comfortable.
And after that, I never looked back.
Because I know oftentimes when I tell people, oh, tell me about your bowel movements.
You know, everyone stiffens up a little bit.
And they too try to match my level of medicalization.
And if you could just tell me what's bothering you, i want to use whatever words make you comfortable.
So i think someone should lead with the words they want to use.
That allows you to talk about it most freely, and my hope is that your doctor is going to meet you right there.
Okay, that's great.
It's funny, bowel movement.
So my name's Brett McKay.
This is sort of a tangent.
So, when you get the initial things, it started when I was in like middle school because I got really self-conscious about it.
Initial BM.
Oh my gosh.
And I had some kid be like, oh, BM, poop.
And so now, ever since then, I do BHM.
That's my middle initial.
Oh, my gosh.
Now you should embrace it.
I've embraced TP as a gastroenterologist.
All right.
So if you can do that, I can go back to BM.
I'm going to embrace the BM.
100%.
So you describe this idea of puphoria in your book.
What is puphoria?
Yeah, Poo-phoria.
It is a state that I want everyone to reach.
And that is where having a bowel movement is the absolute least of your daily concerns.
It's this easy, effortless thing that happens quickly without straining.
And then you go about the rest of your day and live your best life.
You're not worried about feeling heavy for the rest of the morning or day because you didn't have that window to go, or you're worried should I go out to brunch with my friends, or should I even meet people for dinner because I'm so worried about the bathroom situation?
That's not.
I don't want you to live like that And tragically, I think a lot of people are right now.
So Puforia is a state of mind and it's a lifestyle that I think we can all reach, some of us with just a little bit more knowledge about our bowel habits.
That we just never got, because we The last time we talked about our bowel habits with another soul was usually when we were potty training with our mom and dad.
And that was a long time ago.
Most of us cannot remember that conversation.
So a healthy bowel movement?
You're not even thinking about it because it's just not even on.
You don't have to worry about it at all.
Yeah.
You're not obsessed about.
I mean, there's another end of the spectrum where people I mean and this can be quite understandable, but people fixate on their bowel movements all the time.
Like they're worried about like, did I go yet today?
If I don't go, I feel off.
And You know, even if there's someone who you might look from the outside and say okay, they're going once a day, they're regular.
But if you're thinking about it all the time, you're becoming paranoid.
If you haven't gone, that's not poop for you either.
Well, let's talk about what healthy poop looks like.
And hopefully we can answer some questions that people have always wondered about it.
Let's start with the color of poop.
First off, why is poop usually brown?
Yeah, the natural color is actually not brown.
The natural color of our poop is like this whitish clay colored, like kind of like a grayish.
And what gives it its beautiful brown color is... bile.
So our body produces this digestive juice and it has bilirubin in it.
And that's just this chemical that gives it that brown color.
But if we were to take that away, it would actually look bizarrely whitish.
And that is why if you ever see like a pale white whitish creamy stool, that's a problem.
That's an emergency.
It means that that bile is somehow being blocked somewhere.
Maybe it's a gallstone.
It could even be a cancer.
But if you ever see that, that's a big, big red flag.
Go to the emergency room.
But then other than that, the normal color should be some shade of brown.
And then, of course, everybody poops the rainbow from time to time.
I get these kinds of DMs like every week where someone's like I had a really weird purple poop or my poop was kind of greenish.
Is that normal?
And it can be normal.
A lot of times we eat things that we don't put together could impact our poop.
Like, for example...
A classic one is beets.
If you've ever eaten beets, you are probably going to have a maroon poop the next day, or maybe the next day or two.
And that's just the beets.
That's okay.
But if you haven't eaten those beets and you see anything that looks like red, that would be really worrisome for bleeding.
So like bright red, maroon, or even like pitch black and shiny, that could all be blood.
Gotcha.
So yeah, black poo, that could be okay.
Sometimes it suggests there's some sort of internal bleeding going on up your tract, but sometimes there's like I think iron supplementation can cause black poop.
Yeah.
Yeah, you can have this real chicken and egg situation, because sometimes people are taking iron because they're having some bleeding and they've lost blood.
But then you see black poop and you're like, is this because you're taking iron to treat bleeding or is it because you're bleeding?
Yeah.
And then I guess Pepto-Bismol can also cause black poop.
Yeah, I feel like we always forget to warn people about Pepto-Bismol, because it can turn your tongue black, it can make your poop black, and then people are really horrified the next day.
But if you've taken Pepto-Bismol, black poop, you're allowed to have a few black poops.
And another interesting fact about Pepto-Bismol that you put in the book is that if you don't want your farts to stink before a date or something, take Pepto-Bismol before and that will make your farts less stinky.
Okay, so poop's naturally clay color until it meets with bile.
But this is one of those things that can freak me out because like, I mean, you hear if you have like a clay colored stool, you know, that can mean you have pancreatic cancer or bile duct blockage. and i can be looking at a light poop thinking like is that a is that clay color like i think there are different colors of clay and i think well clay's maybe a light tan so maybe my poop is looking like clay but we're talking about like white clay like it has to be basically white Yeah, I guess you're right.
There's like nice different, there's earthy tones of clay.
This I'm talking about more like a whitish creamy color or kind of gray.
And I would say you know when in doubt, I mean, everyone's poop is going to look a little different.
If you have any doubts, I always tell my patients, pics or it didn't happen.
Take a picture of it and then send it through your like electronic medical record and show your doctor and just like have them lay eyes on it.
A doctor will be able to tell you really quickly, am I worried or excited about this or not?
And then red if you haven't eaten beets.
If you see red, that's another thing you might want to go see your doctor about.
Because it could be colon cancer.
But it could be something as benign as a hemorrhoid or an anal fissure or something like that.
Totally.
Yeah.
And most of the time, you know, it is going to be something not worrisome.
It's going to be a hemorrhoid.
But what I never want someone to do especially in this stage in 2026, where we are seeing this really disturbing phenomenon rise in early onset colorectal cancer is for someone to see bleeding and brush it aside.
I mean, this is the trend we're seeing in studies and, with this rising cases that young people when they see blood they're like this is just my hemorrhoid or I'm pretty sure this is no big deal.
It's always better to just quickly let your doctor know and let your doctor reassure you and be like, oh yeah, we'll just do a quick exam.
We'll make sure it's your hemorrhoid.
No problem.
But make sure that someone's taking a look and giving you that reassurance rather than just brush it off yourself.
Let's talk about the shape and consistency.
What does a healthy poop consistency and shape look like?
Yeah, I think most people think that a perfect shape would be like this nice, like smooth, sausage shaped.
And then you go and like people really aim to get this like wipeless wonder.
And that is wonderful.
That is like a nice consistency that a lot of people have.
But there's really such a range of what could be normal.
And I would tell people that...
For the most part, if you start eating a lot more fiber, which a lot of us are not doing, like 95 of Americans are not meeting our fiber goals.
If you start to do that, it actually becomes less and less likely that you're going to have that smooth little sausage that everyone wants.
You're going to start to have fluffier and fluffier stool.
You might even start to go more often. that's perfectly normal.
It can be totally normal.
And people sometimes, when they do that, they're like I have diarrhea because I'm going three times a day and it's so soft.
That's fine.
As long as it's not like interfering with your social life, there's a range of normal.
And in fact you should embrace that new you, because it means you're doing something healthy for yourself.
And then You know, on the flip side sometimes, when people are having these like really, really tiny rabbit pellets, usually I say that that indicates that there's an issue with constipation.
But sometimes the fix can also be quite simple.
It can be you need to hydrate more or you need to not hold it in.
We do that as adults.
We have this urge to go.
Sometimes it's like when we're at work or we're on a date at a restaurant and we say no no no, I'm not going to go right now.
I feel the urge.
I'm not going to go.
And when you do that, you're setting yourself up for failure, because that stool is just going to dry up and become more hard, so that when you decide you want to go later.
It's not the same one that you started with 12 hours ago.
It's a totally different one.
It's going to be more pebbly.
So it's better to try to go when your body tells you to, and you're going to get a little bit closer to that median.
Gotcha.
So what happens to our stool whenever we get diarrheas?
Why does the body decide this stuff needs to be liquid and get out fast?
Like what's happening there?
Yeah, there's lots of different causes.
But in terms of your anatomy, your small bowel, which is that first part of the tube after your stomach.
The main point of your small bowel is to absorb all the nutrients.
And it's sucking out everything that it wants and breaking it down.
And then the stuff that it can't break down, which is usually like the fiber, which we actually don't possess the enzymes to break down.
It makes its way to our microbiome in our colon.
Well, the colon has several jobs.
One of them is to suck water out of the stool as it passes through.
And stool passes a little bit more slowly through the colon.
So your colon has a lot of time to get that water out.
But if something happens that triggers that poop to move forward, and sometimes it's stress.
Stress can cause our colon to suddenly start to contract.
That means we haven't had time to remove and absorb all the water out of it yet, so it's going to gush out like diarrhea when we're stressed.
Spicy food does that.
Spicy food sends this signal down to say okay evacuate everything we have.
That too will make whatever comes out to be a little bit fiery, a little uncomfortable, and it'll also be pretty liquidy.
And then there's other things like infections or just depending on how things are going with other aspects of your life, travel and exercise.
Those things can also help speed things up before you've really had a chance to absorb all the water.
Gotcha.
And constipation is just the reverse.
It's been in the colon too long.
So all that water has been sucked out.
Yeah, exactly.
And there's a ton of different reasons why we think slow down and why we can get constipated.
And you're right.
The longer we sit there, the longer that stool is just.
Your colon is going to keep doing its job and it's going to keep making it harder and harder, which is why I sometimes think the most important thing people can do who are constipated is, just as soon as they hear that call, feel that urge respond because it's not going to be the same poop later on.
What causes constipation?
You said there's lots of potential sources.
Yeah.
Well, when someone comes into my clinic and they have constipation, I try to explain the way the colon works in terms of trying to get toothpaste out of a toothpaste tube.
So sometimes the issue is that we're not squeezing that toothpaste tube.
And that means that maybe there's something that's stopping the colon from contracting so much.
We need to do that.
We need to generate pressure in order to push the stool outwards.
And maybe the problem is actually not that we're not squeezing the tube, but that the toothpaste itself is rock solid.
And sometimes that happens because maybe we're not getting enough fiber.
Maybe we're not drinking enough.
Maybe there's something else that's making that stool really, really hard.
But then the third and, I think, most underappreciated part of the problem is that yeah, we're squeezing hard enough, the toothpaste is super soft, but we forget to take the cap off the toothpaste tube.
And then we're just pressing up against this pelvic floor that is not cooperating.
And that is very common.
That happens to about one in three people sometimes who have constipation and who have tried different laxatives and different things and they've failed.
And basically what that means is that our pelvic floor, which is this set of more than a dozen muscles sitting there at the bottom of our rectums, and they need to coordinate in this really highly orchestrated dance.
Some need to contract at the right time, some need to relax.
And for a lot of people, the sphincters that are supposed to be relaxing actually contract when we bear down.
If you think about it, we're like generating all this pressure to try to push our poop out and people's sphincters contract.
And that's very paradoxical.
It's not supposed to do that.
So sometimes, when you've tried everything, the most obvious answer is actually something that doesn't involve anything, anything related to your colon, but actually it's all the muscles in your pelvis that's the problem.
Yeah, you just went through what you call the three Ps of a good poop.
So propulsion, that's that bearing down, that Vesalva maneuver.
We kind of get that thing going.
Then the consistency, it's the pliability, the softness.
If it's hard, it's not going to come out.
And that pelvic floor aspect, sort of the cap on the toothpaste.
Yeah.
And I think for someone to reach Poophoria and to have healthy, effortless bowel movements every day, you have to think about how you're optimizing all three of those things.
All three of those things need to be working at their best in order to have a bowel movement.
Because if even just one of them is off, it's going to be hard to overcome it with just the other two.
With the pelvic floor piece.
I think we think about that with just women, because pelvic floor problems can result after childbirth, but men can have pelvic floor problems too.
And you recommend that if you have a pelvic floor issue, to go to a physical therapist who specializes in that.
We'll talk about something else you can do to help your pelvic floor when you're pooping later on in our conversation.
Going to the pliability part of the three Ps of a good poop, this is the consistency of the poop.
Why does poop float sometimes?
Yeah, a couple of different reasons.
Sometimes, if it's just soft enough because it has enough soluble material, like enough fiber, it'll float.
Sometimes fat, like fat floats in poop.
So it depends on kind of what you've eaten and how well you've absorbed it.
There are certain conditions where people do not absorb nutrients and the food that they eat as well as we'd like them to.
And traditionally, we think about those as resulting in like really serious floaters.
So there's like a range that could be normal.
But if this is your consistent pattern and you have any other symptoms, like you get pain bloating when you eat,
If you have a lot of floaters in your stool, you should actually just run that by somebody and make sure that you don't have an issue with absorption.
Gotcha.
I mean.
So this is always a concern for me, because I read these articles like oh, pancreatic cancer, colon cancer, and it's like oh, floating poop.
And I'm like, okay, I'm going to be TMI here, but like mine are regular floaters.
They look normal.
They feel normal.
I think it's because I just eat a lot of fiber.
I eat like 60 grams of fiber.
Good for you.
So I think that's what it is.
Am I right?
Or should I go see my doctor?
Yeah.
Well, you should always run anything by your doctor you're concerned about, but what you've described sounds very, very typical for somebody who's just eating a lot of fiber.
Once we start eating a lot of fiber and 60 grams is like an A-plus amount of fiber then people's poop does change and people are really caught off guard by it.
The reason people say that floating poop is a sign of pancreatic cancer is because the pancreas helps break down and helps you absorb that food.
And when suddenly that stops working, so well, then you might see new floating poop for the first time.
But that's not the only sign often.
Like sometimes people, their skin turns a little yellow, they have pain in their stomach.
So if you're otherwise living your best life, run it by your doctor, but it's most likely just because you're eating a ton of fiber, which is a great thing.
Yeah, I'm a big, I'm a fiber maxer, as the kids are saying these days.
Yeah, yeah, me too.
Let's talk about the schedule.
What does a healthy bowel movement schedule look like?
Because I think there's this idea that you have to have a daily constitutional to be healthy.
Is there anything to that idea?
There definitely is something to that idea, and I think that this is because our bodies are naturally primed to have a bowel movement first thing in the morning.
And the reason for that is one of the things that makes the colon a little bit different and special compared to other organs in our bodies is it really operates on a circadian rhythm and it's a creature of habit.
So when we go to sleep, the colon goes into this really quiet state.
It doesn't move around too much.
That's why, for the most part, people sometimes talk about waking up in the middle of the night to go pee.
It's pretty rare for people to wake up in the middle of the night to have to poop.
And that's because your colon's not really moving.
But when it wakes up, when you wake up and it operates on the same circadian clock as you, then that first one to two hours upon waking is when you see some of the strongest contractions naturally occurring in your colon that you're ever going to get the rest of the day.
For that 24-hour period.
It's during those first one to two hours that your colon is doing the work for you.
And if you have a bowel movement when your colon is already contracting, it means you have to do way less work.
You have to bear down less.
You start to stack on other habits that help the colon contract too.
Like, for example, a third of people who drink coffee.
Their colon is gonna start to contract pretty quickly.
People who go for walks in the morning.
Just a little exercise can help stimulate those contractions.
And we do a lot of those things early in the morning.
So it's a great time to have a bowel movement.
All of that said, There's just like a large portion of people whose mornings are totally hectic, totally crazy.
They don't have time for any of this and they don't go.
That doesn't mean that you have a problem or that you're weird.
It just means that you need to find a time to respond when your colon's ready.
And some other times during the day the colon will start contracting If you eat a meal so oftentimes.
There's another wave of people who poop after dinner or poop after lunch.
That's totally normal.
A lot of times people come to my clinic and they're like it's so weird that I have to poop every time I eat.
And I say, no, no, that's a completely normal reflex.
In fact, it's like a reflex that we're born with.
Kids are pooping multiple times a day response to eating, and then later on, as adults, we try to suppress that and try not to respond to that reflex for no reason whatsoever.
We should just respond, but it's actually a perfectly normal part of our human physiology.
So there's a range of what I'd consider normal and what I usually tell people is no, it's not once a day.
If you go once a day wonderful, but you don't have to do that in order to be closer to God, and What I do want you to do is have an effortless bowel movement.
Whenever you go, it should be easy.
If you go once a day but you're straining your eyeballs out for 20 minutes, I wouldn't consider that normal.
So they've done a study in the US where they found that People who consider themselves to have normal bowel movements go anywhere from once every three days to up to three times a day.
And anywhere in that big range could be considered normal, as long as you know it's effortless and you're comfortable and happy with that pattern.
And I imagine, if you see a change in your schedule that lasts a long time, you're like well, maybe I should look at this.
So if I usually do once a day and then I'm going three times a day, well, that's interesting.
I should probably check that out.
Yes.
I tell people to get to know your own pattern.
And everyone's going to be different and have some variation in their own life.
Like you, might be somebody who goes like clockwork every day, and that's perfectly wonderful and healthy.
But you may also see that you have some variations depending on whatever else you have during your week and how you travel and how you exercise.
These things will change, but get to know what kinds of patterns are normal for you.
And then most importantly, you should start looking every day.
Like before you flush, have a peek.
The number of times I ask people, well, what did it look like?
What color is your poop normally?
And people just get all embarrassed and say, oh, I don't know.
I don't really look.
Well, I mean, first of all, how can you not look?
I don't know how you resist that temptation, but you should look, so that then you know when something is different.
Speaking of looking, have you kept up with these new AI devices you can attach to your toilet that takes a picture of your poop?
I've seen some of that chatter.
I'm excited about it.
I think we're all like, oh my gosh, a little horrified about the idea of a camera down there, but I'm sure they've sorted out the privacy issues.
Right.
But I think, well, yeah, I mean, I'm excited about what those those could show us one day.
Yeah.
I mean, yeah, I think looking at your poop tells you a lot about your overall health.
We're going to take a quick break for a word from our sponsors.
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And now back to the show.
Speaking of schedules and let's say someone, they're like, I don't poop as often as I want.
It makes me uncomfortable.
I need to take a laxative.
But they're like.
Well, I don't want to take a laxative because I don't want to become dependent on it or something.
Is there a problem with taking laxatives to have a bowel movement?
Yeah, no.
So I have a few thoughts about this.
One is that just to take a big step back, I don't think there's any problem with someone taking a laxative, especially because I know that.
For some people we can help and improve constipation with a lot of these different tweaks and lifestyle changes and a lot of the sort of things I lay out in my book.
But there's also a group of people who have conditions and diseases and changes in the neurons, the nerve cells of their colon that some of these lifestyle changes are just not going to fix.
Constant patient can be a disease like any other disease, like high blood pressure, like diabetes.
And there's no shame in taking a medicine to treat that.
And so I do feel that there's often a lot of shame and a sense of like self-failure, for when you take a laxative, and if that's what you need, to be well.
I don't think that that's the case.
Now, that said, there are a lot of ways to treat it that don't require laxatives.
But know that laxatives are safe.
You should use them as directed by your doctor.
And a lot of the earlier studies that kind of got people worried that you could become dependent on laxatives.
You were somehow damaging your colon.
Ultimately, that data was not very consistent or proved to be robustly true.
So I worry a little bit less about that.
But I will say there are a lot of ways that you can improve your bowel habits, become less constipated, just by changing things about what you're eating and what you're doing and even the position of how you're sitting on the toilet.
I mean, it's very common that people don't want to take a medicines, but you can take things as natural as like kiwis, right.
Like in our grandparents' times.
People were taking prunes, and prunes are incredibly effective.
But I have never successfully convinced a college student to take prunes.
It's like one of those things that people just don't reach for anymore these days.
But kiwis have been shown in multiple randomized control trials two kiwis a day that they are as effective as prunes but they also don't cause bloating, like a lot of these like fiber supplements and prunes can cause.
Kiwis don't seem to do that.
So it's a pretty simple fix that's relatively effective, all things considered.
And it's not really a laxative.
It's actually just something that's high fiber, got a lot of nutrients and is good for you in other ways.
I like prunes.
I'm a prune booster.
You're pro prune.
I'm pro prune.
I mean, it's a dried plum.
What's not to like?
I think they're fantastic.
And I'm sure you've noticed they're like, they're very good at their job.
Oh yeah, for sure.
Yeah.
You mentioned something that I thought was interesting.
I want to talk about say, if you're having problems getting your poop out, you're constipated or it's a struggle.
The position.
So I think people might've seen these things on Instagram, the squatty potty.
Oh yeah.
Is there anything to that?
Does that actually help?
Yeah.
So this is an interesting thing that we've done to ourselves as mankind.
You know we – thousands and thousands of years ago.
I mean they have found like these upright –, chair like potties, like back in the Roman Empire.
But like well before that, we were just squatting.
All of us squat in our most comfortable, natural way to poop.
And we've trained ourselves out of that.
But I have a two year old and a four year old.
And if you ever go to a daycare, you see a bunch of kids in diapers like waddling around.
They all pop the deepest squat when they are pooping.
You know, they don't like go sit in a chair and poop in their diaper.
They squat.
And that's because that's the easiest, most natural way to have a bowel movement.
And here's why you know we talked about the pelvic floor and there's so many muscles that make up the pelvic floor.
One of the muscles there is called the puborectalis muscle.
And if you think about your colon like a long tube, this puborectalis muscle is like this sling that goes across the tube and chokes it closed.
It's almost like your body stepping on its own hose.
And it's like that when we're just sitting around in our chairs like at a desk at work, for example.
And that's kind of a good thing.
Like it's nice to have like that little like extra closure of that door so that there's nothing leaking out.
There's no pressure.
But you don't want that door to be closed.
You don't want there to be a kink in that hose when you're trying to poop.
And that's how we poop though when we sit at this 90 degree angle.
Well, it turns out that if we try to recreate a little bit more of those dynamics of squatting and we don't have to actually squat, because I recognize obviously nobody wants to do that, but if you just raise your knees above the level of your waist, everybody will poop more easily.
They've done these studies that show that yeah, people who identify as having who've been diagnosed with pelvic floor dysfunction identifies constipation.
They poop better when they do that.
But even healthy people who think that they poop just fine.
Studies have shown that when you raise your knees up, even if you think you're already doing really well, you would be amazed at how much better you do.
That's awesome.
So bring your feet up with the stool.
I'm a fan of the squatty potty.
Speaking of the scheduling, there's this famous bit in 30 Rock, the television show, where Liz Lemon talks about every time she walks into a Barnes & Noble, she has to poop.
And I'm like, that happens to me.
I don't know how many times, I mean, I've pooped in Barnes & Noble several times.
As soon as I walk through those doors, I'm like, I gotta poop.
Yes.
What's going on there?
Why do you have to poop when you go to Barnes & Noble?
Yeah.
You are not alone.
That is such a thing.
And it's funny.
It's Barnes and Nobles for some people.
For some people, it's like the Target.
I think the Target is like a big one for a lot of people.
And it's been described like I think it was back in the 1980s.
It was described in the Japanese literature.
Like, what is it about bookstores that make people poop?
And there are a lot of theories about this and I'll give you mine.
I mentioned earlier that your colon is this creature of habit.
And the interesting thing about your colon is that it can be trained to respond and react to external cues, cues in your environment.
That will start contractions and start things to change.
If you go way back in time to remember Ivan Pavlov, the scientist we all learned about in middle school, who used to ring a bell, and then the dogs would come and start salivating, because when he rang the bell he brought food in.
But eventually, he would start ringing the bell and not bring food in.
They wouldn't see that there was food, but they'd start salivating anyway.
And that idea tells us that just something about our environment that we've associated once with a good poop or a good moment in our digestive history can start to trigger those same cues and those same movements again when we start to build that into a pattern.
So I think what happens is, one, in order to poop, you have to feel relaxed.
That is like a fundamental truth about pooping, because your sphincters have to relax at that final part.
And I think bookstores put people in that relaxed place.
And a lot of people actually find that they have to read in order to have a bowel movement.
We can talk a little bit more about that, but like just a quick light read, it's just distracting enough.
It gets things moving and helps them feel good about it.
And I think for some people, I've heard this, like it's the smell of the pages.
Something about it triggers disassociation.
And you have one.
You go, maybe you go poop once in a Barnes and Noble and Now, the second time you walk in now, you smell the same pages.
You feel relaxed and happy.
You know it was a pleasant experience last time, so you go again.
And now you've ingrained this pattern.
And it keeps happening.
And now you've got this like whole sensory experience.
Every time you walk into a bookstore that's like a safe space and it's pleasant and you go.
And I think that's how we build habits.
And I also think that's what happens in the Target.
Like you go in there, you pick up your coffee, you're by yourself, you're having a nice walk around and you feel safe and it feels lovely.
And then you have a nice bowel movement.
That's my theory.
Okay, yeah, yeah.
I think there might be something to that.
And if you're going to read in Barnes & Noble, leave the books on the shelf.
Yeah.
Don't bring the merchandise in.
Yeah, no merchandise.
They have a sign that says don't do that.
They know.
They understand.
Well, let's talk about reading on the toilet.
A lot of people do this.
When I was growing up, we didn't have smartphones.
And so I would read like the back of my deodorant.
I read about tampons, like my sister's tampons are there and be like, what's going on?
I mean, it's the only thing there.
You've learned so much.
I learned so much while I was on the toilet.
But a lot of people these days.
They take their smartphones in there and they're on there for a long time.
Why is that a problem?
Yeah.
Yeah.
I was, I was like you, I would learn all 30 weird ingredients on the back of the air freshener.
I would read like the far side comics.
Like people used to have these like little discreet bathroom readers that were just like the kind of reading material that could not actually suck you in.
You know like it would be like yeah.
Toilet books.
Yeah.
And it would be like a quick read just to distract your mind for a few minutes.
It would be like last week's sports section of the newspaper.
Whatever it was, you do it, you'd relax, you get the job done, and you'd move on.
Today, you never see those little bathroom bookshelves anymore.
Nobody has that because we're all bringing our smartphones in.
And the problem is that just like we've learned in other spheres, like...
When we're trying to go to sleep or when we're trying to have some social connection at the dinner table.
The smartphones distract us and really hijack our brains to keep us fully engaged with whatever app we're on.
The same thing happens in the bathroom.
And so we did this study in my laboratory two years ago where...
We asked people who were coming in for their screening colonoscopy all about their bowel habits and whether they used their smartphone on the toilet.
And then we looked to see when we did their colonoscopies whether they had hemorrhoids or not.
And it turns out that one yes, all of us are bringing our smartphones in.
Like two thirds of the people who we interviewed were bringing their smartphones into the bathroom.
But the ones who did, they were 46% more likely to have hemorrhoids.
So yikes.
And then two.
They were five times as likely to be spending more than five minutes at a time in the bathroom just bringing your smartphone in.
And that was after controlling and taking into account how constipated they were or how much they strained.
Those things were actually, there were no differences between the smartphone users and not.
So really what we think is the problem is the time.
The amount of time you spend there sitting on this open bowl with no pelvic floor support.
Hemorrhoids are just these cushions of veins.
And those veins eventually start to passively fill with blood.
And when they become engorged, they pop out.
That's when we call them hemorrhoids.
And that's when we say they're uncomfortable and painful.
But if you sit there like that, it's not gonna happen after just doing it for one time.
But if that's your pattern, you do that every day for weeks to years.
Eventually we think that connective tissue around them weakens and you get a problem.
So that's why we tell people One, bring back the old fashioned bathroom reader like, throw in that, like weird old comic book that you actually can only read one page of for you to move on, or just set like a two TikTok limit.
But sometimes I go into these public bathrooms like at work and like I'll hear somebody watching an episode of The Pit.
That happened to me last week.
And I was like, first of all, I know what episodes you're on.
And like, this is not the place.
Like, just pull your pants up and go watch it at your desk.
You don't have to do this in the current compromised position that you're in.
All right.
So you limit your time on the toilet unless you want hemorrhoids, and hemorrhoids aren't fun.
Yeah, exactly.
No, indeed.
Speaking of going to the bathroom in public, a lot of people have problems with that.
And some people we talked about earlier.
They feel relaxed enough to poop at Target.
But some people don't feel comfortable pooping in a public bathroom.
But, as you said earlier, if you feel on that urge, you should probably go, if you don't want to get constipated.
So how do you get over that, I don't know, reluctance to go to the bathroom in public?
Yeah, it's a lot of strategizing, but I do feel really strongly about this that you should go when your body tells you it's time to go, because you're going to make it harder on yourself and you're going to strain harder later if you don't respond.
And so one, I think, and this is something that medical doctors are just surprisingly very good at.
You should identify well in advance, do a reconnaissance mission.
What are the safest bathrooms in your building?
What is the safest bathroom if it's not in your building, in the cafe next door or at the Barnes and Nobles nearby?
If you're out in public, find what the safe, quiet bathroom is well in advance.
And then don't share that secret with anyone.
Keep it to yourself.
But if you're in a situation where you are like just caught with whatever, your bathroom is on hand and there's lots of people there, I actually sometimes tell people put some headphones in and just tune out, like do a noise canceling thing or play some nice music, so that you're not distracted and worried and thinking about what everyone else is doing.
And you're so worried that everyone's thinking about you and they're listening for any sound you might be making.
And once you just tune them out and put the headphones in, it can really help you just focus on the moment at hand, because your goal is to just get in and out too.
And this actually goes two ways.
If you're somebody who's sitting in a stall and since somebody else comes in next to you and has to go and you're just sitting there on TikTok, you have to be a good citizen, right.
And pull your pants up and get out of there.
Don't keep scrolling because you have to do unto others as you'd like to be treated yourself.
And I guess the other thing I tell people to do is you can make a little bit of white noise if you need to, if you really feel like you have to.
You can shake the toilet paper holder.
You can like play some alarm ringtone on your cell phone and something to distract yourself and distract everybody else, if you really feel like you want to.
I actually, I don't mind going to the bathroom in public.
And like when I hear when other people are taking care of business, I'm like okay, you're taking care of business.
That's what you're supposed to do here.
Yeah, good for you.
You're in the right spot.
You're in the right spot, you know?
Besides pooping in public, one thing that can throw off your bowel movement schedule is traveling.
I've got an issue with this.
Whenever I travel, my intestines are just like, we've closed up shop.
Yes.
What's going on there?
Yeah, this is very, very common.
When we travel, a lot of different factors conspire against our colon at the same time.
So first of all, your colon operates on a circadian rhythm.
And let's suppose you're going to Europe for spring break.
And suddenly your colon is waking up like at 2 am and it's not actually time to go and it's all thrown off.
Or you start to sleep in late.
You don't wake up on time.
You sleep in.
Maybe you would usually drink coffee in the morning and take the dog for a walk.
Now you're not doing that.
Now you're... lounging in bed and just transferring your body from bed to beach.
And you're not doing all those things that usually prime your body successfully for bowel movement.
And then second, I mean a lot of us this is myself included the best part of travel is the food, half the time,
Like we go, we want to try local cuisine.
But you know, when you go to Europe and this is what I see with a You should go eat the local food for sure, but you can't eat six bowls of pasta in a row without any form of impunity.
And I really think that people need to aggressively seek out fiber when they're on vacation more so than they would at home.
If you eat a ton of fiber at home and then suddenly you eat half of that or less than half of that, your colon's going to respond and react and it's not going to be happy.
And then lastly, I think people do get dehydrated on vacation.
People are drinking more often, like alcoholic beverages.
They're out walking around, being tourists.
They're just not drinking as much water.
And all of these things together.
And let's not even forget about the fact that we're stressed because we're traveling with our families half the time, or maybe we have to share a bathroom with our cousins.
All of these things come together at once, and it makes it really hard to stay regular.
Okay.
So I think we've covered a lot here about poop.
Let's say we've taken care of business.
There's the wiping part, but you make the case for the bidet.
Why do you think everyone should get a bidet?
I love a bidet and you'll never meet somebody who has a bidet who feels like just medium about it.
Once you try.
Yeah, we got a bidet a couple of years ago and I'm like, everyone should have this.
What have we been doing in the United States that we haven't had this before?
Exactly.
You feel like you're born again.
It's like you want to make sure everybody knows about this.
You make people feel bad if they haven't seen the light.
Like that's what bidets do to you.
It's obnoxious.
But bidets are so wonderful.
And the weird thing is like well, you know, and I talk about this all the time, and normally the pushback I get from Americans who haven't tried them before is like One, this is really weird.
Why would I want anything touching me back there?
And first of all, obviously bidets are for external use only, but it's not any weirder.
If you take a step back, wiping is the weirdest thing we can do, right?
Like if I saw, you know, I mentioned I had a two year old.
If I'm changing his diaper when he was a baby and I got a little poop on my hand, this happens.
The last thing I would do is just wipe that poop off my hand with a paper towel and then just go about my day.
Yeah.
As normal.
Yeah.
The analogy I've heard is like if you've got, if you're out in the garden working and you got mud on your arm, like you wouldn't get a paper towel and just rub the mud because like it wouldn't come off.
You would put it underneath the sink.
And that's mud.
Yeah.
Totally.
You got to get some water on that.
And yet, for some reason, this like absolute most delicate part of our body.
I think this part is underappreciated.
That area... that skin is actually quite delicate.
I think we think it must be so sturdy because it's standing up against yucky poop, but actually it's really soft and delicate and it can tear quite easily.
A bidet is gentle, clean, hygienic.
And I found a lot of people who don't even realize they're the kind that would benefit from it.
Like you know, I tell people who I treat a lot of patients who have Parkinson's disease or trouble moving.
They love bidets because they don't have to worry about balancing and reaching back there.
A bidet just takes care of that.
But actually like everyone would benefit from it.
Think about women who are on their periods.
A bidet is so delightful because you have a lot going on at once half the time.
When you're postpartum, a bidet is lovely because you want to be very gentle.
People who have hemorrhoids, people who have fissures.
People who just have really hairy bums.
People feel like just wiping and it doesn't really like get everything out when you have a lot of hair back there.
A bidet solves all of this for you.
Yeah.
No more dingleberries.
Yeah.
And then you can get like the kind with the like heated seats and stuff.
Oh yeah.
That's what we have.
And then it's got a fan.
So after you're done, it dries your butt.
Yeah.
Just dry it.
Full service.
Yeah.
And they're affordable.
They're not that expensive and they're easy to install.
Like you don't have to get like a separate bidet that you put next to your toilet.
It's just, it's an attachment right on your toilet.
Yeah.
And let's just like emphasize, it's an attachment that runs through your clean water supply.
This is a common concern.
Like, are you just splashing dirty water back at you?
Like, absolutely not.
This is splashing clean water.
It goes to your clean water supply.
There's no risk of weird backsplash.
And then some people, if they don't go bidet they will all just use like the wipes, like adult diaper wipes, essentially.
Those are nice, but the problem is you're not supposed to flush them down the toilet.
Exactly.
Even the ones that say flushable, which a lot of them do, you actually can damage your pipes and they're not actually as degradable as we'd like.
So if you're starting to throw those in the little can next to your commode eventually, when those build up, you're like why didn't I just get up a day?
Like that's not pleasant either.
It's interesting, the cultural differences about wiping.
So I lived in Mexico for two years when I was in my 20s.
And I remember when I first got there and I was living with some Mexicans a lot of them don't flush the toilet paper.
They'd have like a wastebasket and they just wipe and put it in the trash.
I'm like, that's interesting.
So I had to start doing that.
It was kind of weird for two years to... wipe and then throw it away.
I saw that a lot in Europe too, where there was no bidets and like in Morocco when I was traveling.
And I think it's like a plumbing issue.
Like the pipes were really old and like you have to be really careful.
But like good God, what if ever there was a sign to get a bidet at that point?
But if you do have to wipe, you suggest not to wipe, but to blot.
Yeah, I'm a blotter or a dabber.
I like a dab.
And again, that's because I see people, you know, like in my line of work.
People are often prepping for colonoscopies or they have some condition where they have diarrhea and they're constantly wiping.
That area just gets inflamed and red and unhappy very, very quickly if you're doing a lot of wiping.
Just dab.
You don't need to go overly aggressive.
Just dab because that skin is so, so delicate.
So, speaking to this pliability of the three Ps of pooping making our poops easy to get out what can we eat for optimal poop health?
Well, there's three layers of what I tell people to do.
The first one is eat more fiber.
And actually, if I could do nothing else, that's like one, two and three, because we're all struggling.
I'm actually delighted that you hit 60 grams.
For men under 50, it's like 38 grams.
For women, it's 25.
And a lot of us just aren't meeting that.
So if you can do that by any means necessary, even if that's a fiber supplement, I would chalk that as a win.
But the second sort of thing that has been shown, like if you're doing that and you're ready for the 102 level course, the second thing that's really been shown to help with your gut microbiome.
So those are the trillions of microbes living in your colon, and their genetic material is to have a diversity of plant-based sources in your diet every week.
And that contributes to the diversity of those microbes.
And you want that.
That's a marker of good health and of a healthy microbiome is the different numbers of species in there.
And those microbes, just remember, they're not just sitting there.
They're not passive actors in your colon.
They're taking what you're feeding them and fermenting it and creating these new compounds, which sometimes are called postbiotics.
But they're things like short-chain fatty acids that get absorbed into the bloodstream and go to other parts of your body.
So it is really important what you feed them and how you think about them.
Eating a diversity of plants is the second thing that I tell people to try to aim to do.
So meaning like don't eat the same routine thing every single day for lunch, every single day for dinner, like start to diversify that.
But then three, and this is, I think, the hardest one.
The 103 level course is to start incorporating fermented foods into your diet.
This is like the thing that every gastroenterologist like loves to preach about.
But there have been some really powerful studies showing how even two groups of people both eating a high fiber diet, when one of them adds fermented foods, their microbes produce even more anti-inflammatory compounds, and you can measure those in the blood.
And so fermented foods are like kind of hard.
Sometimes they're not like necessarily the obvious things that we think of in a typical American diet, but you can get them through, just like Greek yogurt, which is the most common thing that I usually eat and incorporate into my diet every day because it's very filling.
It's like makes a great breakfast.
I eat it that way, but it's also stuff like kombucha, sauerkraut, kimchi.
They're even present to some extent in like sourdough bread or soy sauce.
Like they're there.
So the more you can incorporate and start getting in the habit of throwing in fermented foods into your diet, like that'll give you even that extra boost.
So yeah, my morning, my diet in the morning is like my colon morning.
So in the morning I have eggs with these like fiber wraps.
That's where I get a lot of the fibers, these fiber wraps.
And then I have like a mid-morning meal where I'll have oatmeal.
Or it could be like a high fiber cereal.
And then I'll put some Greek yogurt in there and then some blueberries.
And then I also eat some either sauerkraut or kimchi with my eggs first thing in the morning.
Oh, wow.
I love that.
That's like a perfect breakfast.
You've got all of the components in there.
Yeah.
Well, Trisha, this has been an amazing conversation.
I've been doing this for 17 years.
I never thought I'd have a podcast about poop, but I did.
It was a great one.
Where can people go to learn more about the book and your work?
Well, they can get the book, You've Been Pooping All Wrong, anywhere that they get books.
And they can follow me on Instagram at Trisha Pasricha, MD.
Fantastic.
Well, Dr. Trisha Pasricha, thanks for your time.
It's been a pleasure.
Thanks, Brett.
This was so much fun.
My guest today was Dr. Trisha Pashricha, the author of You've Been Pooping All Wrong.
It's available on amazon.com and bookstores everywhere.
You can find more information about her work at our website, trishapashricha.com.
Also check out our show notes at aomis slash poop, where you can find links to resources where you can delve deeper into this topic, including an article on our top 10 toilet books, so you can start building your bathroom library.
Well, that wraps up another edition of the A1 Podcast.
If you haven't done so already, I'd appreciate it if you take one minute to give us a review on the podcast player you use.
And if you've done that already, thank you.
Please consider sharing the show with a friend or family member who you think got something out of it.
As always, thank you for the continued support.
Until next time, it's Brett McKay.
Remind you not to listen to A1 Podcast, but put what you've heard into action.
Thank you.
Before you go, here's another episode worth adding to the queue.
In episode number 821 we explore why routines, especially over rigid ones, can actually make life harder, not easier.
We talk discipline without obsession, structure without rigidity, and where real growth comes from.
You can find it at aom.is slash routines.
That's aom.is slash routines.
Go check it out, episode number 821.
